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- ItemAcesso aberto (Open Access)Achados oculares em pacientes com mielomeningocele: 72 casos(Conselho Brasileiro de Oftalmologia, 2000-10-01) Cronemberger, Monica Fialho [UNIFESP]; Tabuse, Marcia Keiko Uyeno [UNIFESP]; Aguilar, Luis Tibiriça [UNIFESP]; Costa, Marcelo Fernandes Da; Ferraretto, Ivan; Associação de Assistência à Criança Defeituosa; Universidade Federal de São Paulo (UNIFESP); Associação de Assistência à Criança DeficientePurpose: To study ocular findings in patients with meningomyelocele. Methods: A retrospective study of 72 patients with myelomeningocele was performed to evaluate ocular motility disorders, refractive errors and indirect ophthalmoscopy findings. Results: In a group of 72 patients with myelomeningocele, aged 5 month -- 18 years, 64 (88.9%) had hydrocephalus. Of this group of 64 patients, 36 (56.3%) had strabismus, 21 (58.3%) of whom were esotropic, and 13 (36.1%) exotropic, 1 (2.8%) exophoric and 1 (2.8%) presented sometimes esotropia and sometimes exotropia. Of the total of 72 studied patients, 38 (52.8%) had strabismus. Anisotropia was found in 16 (22.2%) patients, 14 (87.5%) with an A pattern and 2 (12.5%) with a V pattern. The most frequent refractive error was hyperopia, found in 64 (44.4%) eyes. All the 16 patients with anisotropia had hydrocephalus. Atrophy of the optic nerve was found in 9 (12.5%) patients. Conclusion: Myelomeningocele associated with hydrocephalus had a higher percentage of strabismus than the normal population.
- ItemAcesso aberto (Open Access)Alterações anatômicas da base do crânio nas mielomeningoceles tratadas intra-útero e após o nascimento(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Costa, Marcos Devanir Silva Da [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; http://lattes.cnpq.br/2579601954596213; http://lattes.cnpq.br/7948587682857585; Universidade Federal de São Paulo (UNIFESP)Objective: Analyze the skull base of patients that underwent to fetal myelomeningocele repair and compare them to patients submitted to postnatal correction surgery and to a normal control group. Methods: We retrospectively analyzed the records of patients from the Post Natal Group with individuals who underwent myelomeningocele correction surgery up to 48 hours after birth, and the Fetal Group consisting of patients undergoing myelomeningocele correction surgery in the period between 19 and 27 weeks and six days of gestation. We compared birth weight, gestational age at birth, ventriculo-peritoneal shunt placement rate, clivus supraocciput angle (an indirect measure of posterior fossa amplitude), Welcher angle, head circumference adjusted for gestational age at birth up to the age of 2 years. For analysis of the supraocciput clivus angle, we used T1-weighted or T2- weighted brain magnetic resonance in sagittal sections of the postnatal period and a Control Group of individuals which the brain magnetic resonance reveled normal under the age of 5. Results: We selected 70 individuals from the Fetal Group and 68 from the Post Natal Group. A statistically significant difference between the mean supraocciput clivus angle of 87.6o of the Fetal Group was found compared to the mean angle of the of 77.7o of the Post-Natal Group and 89,1o of the Control Group (p <0.0001 in the one-way ANOVA Test). Besides, the mean angle of Welcher in the Fetal Group was 136o , while in the Post Natal Group it was 135o , and 137o in the Control Group, with no statistical difference between the means. Gestational age at birth and sex-adjusted head circumference growth curves were generated and showed that both groups Fetal and Post-Natal had statistically distinct curves, which are within the range of -3 and + 3 score Z of the World Health Organization curves. The comparison of the head circumference growth curves adjusted for sex and gestational age at the birth of the subgroups that used or not acetazolamide in the Fetal Group revealed that patients of both sexes of the group who used the acetazolamide remained tangent to the +3 Score Z while the group that did not use acetazolamide remained between +2 and +3 Score Z. There was 8.5% indication of ventricular-peritoneal shunt or endoscopic third ventriculostomy in the Fetal Group and 76.4% in the Post Natal Group. It was also identified prematurity and low birth weight in the Fetal Group when compared to the Post Natal Group. Conclusion: The increase in the supraocciput clivus angle, which occurs in the intrauterine repaired patients when compared to patients operated after birth, may justify a decrease in the prevalence of hydrocephalus because it represents an increase in the amplitude of the posterior fossa.
- ItemSomente MetadadadosAntenatal management of fetal neurosurgical diseases(Springer, 2017) Cavalheiro, Sergio [UNIFESP]; Silva da Costa, Marcos Devanir [UNIFESP]; Mendonca, Jardel Nicacio [UNIFESP]; Dastoli, Patricia Alesssandra [UNIFESP]; Suriano, Italo Capraro [UNIFESP]; Barbosa, Mauricio Mendes [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.
- ItemSomente MetadadadosComparison of Prenatal and Postnatal Management of Patients with Myelomeningocele(W B Saunders Co-Elsevier Inc, 2017) Cavalheiro, Sergio [UNIFESP]; Silva da Costa, Marcos Devanir [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Leonard, JeffreyMyelomeningocele (MMC) is a costly lifetime disease with many comorbidities, including sensory and motor lower limb disability, bladder/bowel dysfunction, scoliosis, club foot, and hydrocephalus. MMC treatment options have changed over time because routine use of fetal ultrasonography and MRI has provided prenatal diagnosis and the potential for fetal surgery. There is still no consensus on how to treat the MMC diagnoses prenatally, mainly related to the infrastructure required to operate on pregnant patients. This article provides an overview of prenatal and postnatal MMC repair and the features in the prenatal diagnosis.
- ItemAcesso aberto (Open Access)Interferência do comprimento e ou do diâmetro interno do cateter peritoneal no funcionamento do sistema se derivação ventrículo-peritoneal(Universidade Federal de São Paulo (UNIFESP), 2017-07-28) Suriano, Italo Capraro [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; http://lattes.cnpq.br/2579601954596213; http://lattes.cnpq.br/0304205461323542; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate if and how changes in the length or diameter of the peritoneal catheters alter the hydrodynamic characteristics of the peritoneal ventricle derivation systems (DVP). Material and Method: Three peritoneal ventricle shunts were tested from different manufactures, initially with the original manufactured characteristics and after its modification of the peritoneal catheter length from 1200, 1100, 1000, 800 e 600 mm and in its internal diameter from 1.5, 1.2, .1,1 to 1.0 mm. An automatized test bench was used, according to ISO 7197. Result: When they were tested with the original manufactured characteristics, the pressure values remained the same as those reported by the manufacturer. When the size of the peritoneal catheter was decreased above 200 mm, it was observed a decrease in the pressure value of the peritoneal ventricle bypass system, as well as when the diameter of the catheter was increased. When the length of the peritoneal catheter was increased or when its internal diameter was decreased, it was statistically observed an increase in the pressure of the valve (p <0,001). Conclusion: By modifying the characteristics of the peritoneal ventricle bypass systems or, it is possible to alter the system pressures and thus contribute to the increase valve dysfunction.
- ItemSomente MetadadadosTratamento neuroendoscópico dos cistos supra-selares(Universidade Federal de São Paulo (UNIFESP), 2000) Zymberg, Samuel Tau [UNIFESP]; Cavalheiro, Sergio [UNIFESP]No presente estudo, 15 pacientes portadores de cistos de aracnoide supra-selares foram submetidos a ventriculocistocisternostomia endoscopica. A idade variou de dois meses a 34 anos e cinco meses, mediana de seis anos e quatro meses, sendo nove (60 por cento) do sexo masculino e seis (40 por cento) do sexo feminino. Cefaleia, macrocrania, convulsao, ataxia, papiledema, retardo do desenvolvimento e diminuicao da acuidade visual foram os sinais e sintomas mais comuns nesses doentes. As cirurgias tiveram duracao de 24 a 120 minutos, mediana de 50 minutos. Nao foram observadas complicacoes intra ou pos-operatorias em 16 procedimentos realizados. Sete pacientes tiveram seus sistemas de derivacao retirados ao final da cirurgia, dos nove que ja haviam sido tratados anteriormente. Dois foram derivados novamente por desenvolverem quadro de hipertensao intracraniana. No total, 13 pacientes permaneceram independentes de valvula. Foram feitas as medidas dos cistos supra-selares no pre e pos-operatorio tardio, em tres eixos, a partir das imagens por ressonancia magnetica. Houve reducao significante de todos os cistos supra-selares nos tres eixos considerados. Reducoes percentuais maiores foram observadas nos pacientes mais jovens. Tres pacientes desenvolveram puberdade precoce verdadeira meses apos a cirurgia, sendo tratados com exito